Patients at Risk

Physicians train for at least 15,000 hours before we are permitted to practice independently, and one of the reasons is that it takes a long time and a lot of patient volume to be exposed to the many different presentations of disease processes to learn how to recognize true emergencies that need immediate interventions. Today’s guest brings us a perfect example of the importance of this training. Karen Wilson Saintsing DVM is a veterinarian who nearly lost her arm after a nurse practitioner in an urgent care failed to recognize the onset of compartment syndrome. Fortunately, an astute emergency physician immediately recognized the condition and transferred her to a surgical center for treatment.  To help us understand compartment syndrome, we are also joined by trauma surgeon Stephanie Markle DO MPH.PhysiciansForPatientProtection.org

Increasingly, nurse practitioners and physician assistants are being asked to step into the role of physicians. While surgeons and procedural doctors have been fairly insulated from this phenomenon, the tide is beginning to turn. Today we are going to explore the phenomenon of NPs and PAs performing colonoscopies, screening tests for colon cancer. Colorectal surgeon Amer Alame MD discusses the flaws in a study that claims to show that PAs can safely perform colonoscopies.Fejleh MP, Shen C, Chen J, Bushong J, Dieckgraefe, B, Sayuk G. Quality metrics of screening colonoscopies performed by PAs. JAAPA. 2020;33(4):43-48.Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/PhysiciansForPatientProtection.org

Increasingly, nurse practitioners and physician assistants are being asked to step into the role of physicians. While surgeons and procedural doctors have been fairly insulated from this phenomenon, the tide is beginning to turn. Today we are going to explore the phenomenon of NPs and PAs performing colonoscopies, screening tests for colon cancer. Colorectal surgeon Amer Alame MD discusses the flaws in a 2020 Johns Hopkins study advocating for the use of NPs to perform colonoscopies.  Riegert M, Nandwani M, Thul B, Chiu AC, Mathews SC, Khashab MA, Kalloo AN. Experience of nurse practitioners performing colonoscopy after endoscopic training in more than 1,000 patients. Endosc Int Open. 2020 Oct;8(10):E1423-E1428. doi: 10.1055/a-1221-4546. Epub 2020 Sep 22. PMID: 33015346; PMCID: PMC7508647.Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/PhysiciansForPatientProtection.org

Tired of being owned by corporations, but don't want to open your own practice? Stephanie Freeman, MD, a critical care physician and entrepreneur, teaches physicians how to become self-employed through contract work and locums.  Learn more at DrStephanieICU.comhttp://www.freelocumstraining.com for free online locums training.National Association of Locums and Independent Physicianshttp://www.na-lip.comPhysiciansForPatientProtection.org

In Jan 2022, the Journal of Nursing Regulation published an article entitled: Analysis of Nurse Practitioners’ Educational Preparation, Credentialing, and Scope of Practice in U.S. Emergency DepartmentsThe summary:  “Due to the variability in educational preparation, NPs should not perform independent unsupervised care in the ED regardless of state law or hospital regulations.” This unequivocal statement contradicts the rhetoric of NP leadership which insists that NPs should be allowed to practice virtually anywhere and everywhere without supervision. Today I’m joined by family physician Christopher Garofalo, and radiologist and PPP board member Phil Shaffer to discuss this important paper. PhysiciansForPatientProtection.org

Attorney and emergency medicine physician William P. Sullivan believes that nonphysician practitioners should practice independently, but be held to the same medical standard as physicians since NP/PA leaders argue that there is "no difference in the practices and outcomes between physicians and advanced practice providers." Dr. Sullivan joins us to discuss his article on this issue - https://sullivanlegal.us/nurse-practitioner-and-physician-assistant-standard-of-care/Get the book! https://www.amazon.com/dp/B08M9YJQR3/PhysiciansForPatientProtection.org

In several previous podcasts, you have heard us refer to research studies that claim to show that nurse practitioner care is just as good or better than that provided by physicians. We’ve shown that in many of these cases, the study authors are using flawed methodology or failing to disclose important information, like nurse practitioners working under physician supervision.  Today we invite you to attend Patients at Risk’s first “Journal Club” session as we dissect a study that claims to show that having more nurse practitioners working in hospitals improves patient care, and the methodology used by the authors is just about one of the most egregious examples we have ever seen. To help explain this study, we are joined by two physician experts, Dr. Dylan Golomb and Dr. Marsha Haley.  THE BOTTOM LINE: The study authors claim that “having more NPs in hospitals has favorable effects...and adds value to labor resources” - but the methodology they use involves asking nurses to ESTIMATE the number of NPs that work in their hospitals - without any validation that this estimate is accurate.Aiken LH, Sloane DM, Brom HM, Todd BA, Barnes H, Cimiotti JP, Cunningham RS, McHugh MD. Value of Nurse Practitioner Inpatient Hospital Staffing. Med Care. 2021 Oct 1;59(10):857-863. doi: 10.1097/MLR.0000000000001628. PMID: 34432769; PMCID: PMC8446318.GET THE BOOK:  https://www.amazon.com/dp/B08M9YJQR3/PhysiciansForPatientProtection.org

Douglas Farrago MD discusses why '9 out of 10 administrators' absolutely hate his new book, The Hospital Guide to Physician Retention: Why Creating A Physician-Friendly Environment Is Critical For Your Organization’s Success. Dr. Farrago has been fighting to improve the state of medicine for decades, authoring books on direct care and pointing out the fallacies in health care at his blog, AuthenticMedicine.com. His newest book, The Hospital Guide to Physician Retention is focused on improving the work environment of physicians.  "When doctors feel valued and have meaningful relationships with their patients and co-workers, they are much less likely to leave," says Farrago, which saves hospitals up to $1 million per physician. "Happy doctors stay, and happy doctors help recruit other doctors, leading to happier and more satisfied patients."So, why did so many administrators hate this book?   PhysiciansForPatientProtection.org

Sonal Patel MD and Jou Jou Hanna MD discuss the difficult choices that women make to become physicians, and why that training matters.PhysiciansForPatientProtection.org

One topic that gets women physicians fired up like no other is a discussion of gender issues in medicine. While medical school classes are currently made up of about 50% women, women physicians are still a significant minority in medical practice today, and women doctors face serious inequities due to their gender. One of the biggest challenges that women must face is the decision of if or when to have children, because of the intense and lengthy educational training process that doctors must complete.A recent post from a nurse practitioner student who reported feeling guilty about being away from her children while on clinical rotations caused controversy among women physicians. Many women physicians noted that the number of clinical hours that the nurse practitioner student was complaining about was just a fraction of what they have had to go through while other women physicians argued that no woman clinician should have to feel guilt about balancing child-raising with education. Dr. Sonal Patel and Dr JouJou Hanna join us to discuss the nuances of this issue.PhysiciansForPatientProtection.org